Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the hair follicle, usually affecting skin folds where friction and moisture are common. Follicular occlusion causes the follicular-apocrine unit to enlarge and rupture. Keratin and inflammatory contents then enter surrounding tissue, triggering a dysregulated immune response. Repeated episodes heal with scarring and epithelial-lined sinus tracts, so the disease can progress from isolated painful nodules to interconnected tunnels beneath the skin. This mechanism explains why HS can resemble a recurrent abscess but does not behave like a single bacterial boil. Infection may occur secondarily, but infection is not required to explain the chronic pattern. Genetic variants affecting the γ-secretase/Notch pathway and androgen excess may increase susceptibility. Smoking, excess weight, and friction can increase disease burden; these associations should be discussed without implying that the patient caused the condition. The experienced nurse notices the pattern before focusing on one lesion: painful, recurrent nodules or abscess-like areas in both axillae, the groin, inframammary folds, perianal region, or buttocks, often with drainage, scarring, double comedones, or small openings connected by tracts. That pattern determines the...